Clinical characteristics and outcomes of patients with severe left ventricular dysfunction undergoing cardiac MRI viabil
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ORIGINAL PAPER
Clinical characteristics and outcomes of patients with severe left ventricular dysfunction undergoing cardiac MRI viability assessment prior to revascularization Demetrios Doukas1 · Katerina Porcaro1 · Jessica Marot2 · Lucas Burke3 · Cara Joyce4 · Frances Weaver5 · James Nguyen6 · J. Jane Cao6 · Verghese Mathew1 · Alain Heroux1 · Mushabbar A. Syed1,7 Received: 7 June 2020 / Accepted: 23 September 2020 © Springer Nature B.V. 2020
Abstract Coronary artery bypass grafting improves survival in patients with ischemic cardiomyopathy, however, these patients are at high risk for morbidity and mortality. The role of viability testing to guide revascularization in these patients is unclear. Cardiac magnetic resonance imaging (CMR) has not been studied adequately in this population despite being considered a reference standard for infarct imaging. We performed a multicenter retrospective analysis of patients (n = 154) with severe left ventricular systolic dysfunction [ejection fraction (EF) 50% viability on CMR had a 47% reduction in composite events when undergoing revascularization opposed to medical therapy alone (HR 0.53, p = 0.02) whereas patients with a viability 75%) of mid anteroseptum, apical septum and mid inferolateral walls consistent with non-viable myocardium
and cause-specific hazards were computed for these comparisons. For these competing events analyses, the proportional hazards assumption for each event type was assessed as described by Cox and Oakes [8]. Furthermore, a composite event defined as the first adverse event (i.e., death, stroke, myocardial infarction, VT, or hospitalization) following patients’ CMR date was also included. Analyses were performed using SAS 9.4 (SAS Institute, Cary, NC).
Results A total of 154 patients with severe LV dysfunction were included in this study that had CMR viability assessment prior to the decision for revascularization. Patients were collected from the Veterans Affairs Hospitals (n = 45), Loyola University Medical Center (n = 94), and St. Francis Hospital (n = 15). Baseline patient demographic and
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The International Journal of Cardiovascular Imaging
Table 1 Baseline characteristics of patients who underwent viability assessment Characteristic
All patients n = 154
Medical therapy n = 63
Revascularization + med- P value ical therapy n = 91
Male sex—no. (%) Age (years) Body mass index (kg/m2) Mean LV ejection fraction LV EDVI (ml/m2) LV ESVI (ml/m2) Viability score (raw) Viability score % max Tobacco—no. (%) Previous myocardial infarction—no. (%) Prior PCI—no. (%) Diabetes—no. (%) Hypertension—no. (%) Hyperlipidemia—no. (%) Chronic kidney disease—no. (%) Prior cerebrovascular accident—no. (%) Peripheral vascular disease—no. (%) COPD (N = 139)†—no. (%) NYHA FC (N = 135)†—no. (%) Class I Class II Class III Class IV Beta blocker—no. (%) ACE Inhibitors—no. (%) ARB—no. (%) Statin—no. (%) Aspirin—no. (%) P2Y12 inhibitors—no. (%) MRA (N = 139)†—no. (%) ICD/CRT (N = 124)†—no. (%)
126 (82) 67 ± 9.7 29 ± 8 26 ± 7 135 ± 44 101 ± 44 48 ± 11
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